Li Rongxin, Zhao Danyang, Hu Boqi, Li Nan, Li Jing, Lin Weihong
Department of Neurology, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun, China, 130000.
Department of Radiology, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, China, 130000.
Seizure. 2025 Mar;126:99-105. doi: 10.1016/j.seizure.2025.02.011. Epub 2025 Feb 20.
This prospective cohort study aims to provide detailed data on the incidence and risk factors of sudden unexpected death in epilepsy (SUDEP).
We recruited 6,513 patients with convulsive epilepsy from rural areas of Northeast China for regular follow-ups. Mortality cases, including probable and suspected SUDEP, were identified through death certificates, verbal autopsies, and expert panel discussions. We calculated overall, sex-adjusted, and age-specific SUDEP incidence rates, along with cumulative incidence under competing risks. We employed univariate Cox regression analysis and multivariable competing risks regression analysis to identify potential risk factors associated with SUDEP.
The overall SUDEP incidence was 1.46 per 1,000 person-years, with rates of 1.50 for females and 1.42 for males. The cumulative incidence of SUDEP at 1, 3, and 5 years was 0, 1.09‰, and 1.95‰, respectively. SUDEP incidence peaked in individuals aged 30-49 years. Body mass index, age at onset, and recent high-frequency generalized tonic-clonic seizures significantly increased SUDEP risk, with high-frequency seizures being the strongest predictor. Epilepsy duration, consciousness status during seizures, and anti-seizure medication count were not linked to SUDEP. Improved medication adherence, though not directly reducing SUDEP risk, could lower seizure frequency, thus indirectly decreasing SUDEP risk.
High-frequency seizures, younger age at onset, and overweight status significantly increased the risk of SUDEP in patients with convulsive epilepsy. These findings contribute to the development of a SUDEP risk profile, facilitating the precise identification of high-risk individuals and informing prevention and management strategies.
这项前瞻性队列研究旨在提供有关癫痫性猝死（SUDEP）的发病率和危险因素的详细数据。
我们招募了来自中国东北地区农村的6513例惊厥性癫痫患者进行定期随访。通过死亡证明、口头尸检和专家小组讨论确定包括可能和疑似SUDEP在内的死亡病例。我们计算了总体、性别调整和年龄特异性的SUDEP发病率，以及竞争风险下的累积发病率。我们采用单变量Cox回归分析和多变量竞争风险回归分析来确定与SUDEP相关的潜在危险因素。
总体SUDEP发病率为每1000人年1.46例，女性发病率为1.50例，男性为1.42例。SUDEP在1年、3年和5年的累积发病率分别为0、1.09‰和1.95‰。SUDEP发病率在30 - 49岁的个体中达到峰值。体重指数、发病年龄和近期高频全身性强直 - 阵挛发作显著增加了SUDEP风险，其中高频发作是最强的预测因素。癫痫病程、发作时的意识状态和抗癫痫药物数量与SUDEP无关。改善药物依从性虽然不能直接降低SUDEP风险，但可以降低发作频率，从而间接降低SUDEP风险。
高频发作、发病年龄较小和超重状态显著增加了惊厥性癫痫患者的SUDEP风险。这些发现有助于制定SUDEP风险概况，便于准确识别高危个体并为预防和管理策略提供依据。
